Tell Me About You
Date of filling out questionnaire
List any health concerns/conditions that you are experiencing:
Diabetes, high blood pressure, joint pain or other injuries that will affect your ability to exercise
Low Back Pain
High Blood Pressure
Joint injury (current that limits exercise choice)
IBS, Chron's, Leaky Gut
none of the above
Describe your biggest challenge/struggle in the past when it comes to reaching your health and wellness goals. (Nutrition, motivation, time to exercise, work schedule, no family/friend support)
What is your primary reason to get healthier?
Improve a health condition (diabetes, high cholesterol or blood pressure, IBS)
Have more energy
Improve your digestion
Learn how to eat healthy
Boost your immune system
Learn fitness/exercise tips
Accountability and motivation
List your most important attainable goal that you would like to achieve in the next 30 days.
(Make it measurable and specific for the 30 day time period)
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